Role of endoscopy in chronic diarrhoea when functional bowel disease is suspected

We thank Ong and colleagues1 for their comment on the indication for lower GI endoscopy when functional bowel disease such as IBS diarrhoea predominant (IBS-D) is suspected.

In most patients with chronic diarrhoea, some form of endoscopic investigation will be necessary. However, it has been recommended that in young patients (less than 40 years) reporting 'diarrhoea' but who have other typical symptoms of a functional bowel disorder and negative initial investigations including faecal calprotectin, a positive diagnosis of IBS-D may be made in the primary care setting without recourse to further investigations.2

We are concerned that many patients with severe, persistent or atypical symptoms fail to have other specific treatable diagnoses made. Hence, the guidelines subsequently clarify this further within section 4.2, to state 'patients under 40 years without typical symptoms of functional bowel disorder and/or severe symptoms and documented diarrhoea (as previously defined) should have further evaluation'.

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